Racial differences in tumor stage and survival for colorectal cancer in an insured population
Racial differences in tumor stage and survival for colorectal cancer in an insured population
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DOI：
10.1002/cncr.22437
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发表时间：
2007-02-01
期刊：
影响因子：
6.2
通讯作者：
Wagner, Edward H.
中科院分区：
文献类型：
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作者：
Doubeni, Chyke A.;Field, Terry S.;Wagner, Edward H.
背景。尽管结直肠癌（CRC）死亡率下降，但种族差异仍在继续扩大。在这项研究中，作者研究了不同种族的受保患者群体中的差异。方法。这项研究是在 1993 年至 1998 年间被诊断患有结直肠癌的患者中进行的，当时他们被纳入综合医疗系统。患者是从肿瘤登记处识别出来的，并与管理数据库中的信息相关联。样本仅限于非西班牙裔白人 (n = 10,585)、非西班牙裔黑人 (n = 1479)、西班牙裔 (n = 985) 和亚洲人/太平洋岛民 (n = 909)。分别使用多级模型和Cox回归模型分析肿瘤分期和生存率的差异。结果。在多变量回归分析中，黑人比白人更有可能患有远处或未分期的肿瘤。在针对非可变因素进行调整的 Cox 模型中，黑人死于 CRC 的风险较高（风险比 [HR]，1.17；95% 置信区间 [95% CI]，1.06-1.30）。西班牙裔人的死亡风险与白人相似（HR，1.04；95% CI，0.92-1.18），而亚裔/太平洋岛民死于结直肠癌的风险较低（HR，0.89；95% CI，0.78-1.02）。对肿瘤分期的调整将黑人的 HR 降低至 1.11，并且在模型中加入手术治疗将 HR 进一步降低至 1.06。西班牙裔和亚洲人/太平洋岛民的 HR 在调整肿瘤分期和手术治疗后保持稳定。结论。种族与结直肠癌生存率之间的关系很复杂，似乎与肿瘤分期和接受的治疗的差异有关，即使在投保人群中也是如此。可能需要采取有针对性的干预措施来改善弱势群体中有效筛查和治疗的使用，以消除结直肠癌方面的差异。
BACKGROUND. Despite declining death rates from colorectal cancer (CRC), racial disparities have continued to increase. In this study, the authors examined disparities in a racially diverse group of insured patients.METHODS. This study was conducted among patients who were diagnosed with CRC from 1993 to 1998, when they were enrolled in integrated healthcare systems. Patients were identified from tumor registries and were linked to information in administrative databases. The sample was restricted to non-Hispanic whites (n = 10,585), non-Hispanic blacks (n = 1479), Hispanics (n = 985), and Asians/Pacific Islanders (n = 909). Differences in tumor stage and survival were analyzed by using polytomous and Cox regression models, respectively.RESULTS. In multivariable regression analyses, blacks were more likely than whites to have distant or unstaged tumors. In Cox models that were adjusted for nonmutable factors, blacks had a higher risk of death from CRC (hazard ratio [HR], 1.17; 95% confidence interval [95% CI], 1.06-1.30). Hispanics had a risk of death similar to whites (HR, 1.04; 95% CI, 0.92-1.18), whereas Asians/Pacific Islanders had a lower risk of death from CRC (HR, 0.89; 95% CI, 0.78-1.02). Adjustment for tumor stage decreased the HR to 1.11 for blacks, and the addition of receipt of surgical therapy to the model decreased the HR further to 1.06. The HR among Hispanics and Asians/ Pacific Islanders was stable to adjustment for tumor stage and surgical therapy.CONCLUSIONS. The relation between race and survival from CRC was complex and appeared to be related to differences in tumor stage and therapy received, even in insured populations. Targeted interventions to improve the use of effective screening and treatment among vulnerable populations may be needed to eliminate disparities in CRC.